HOW A MINIATURE ENDOSCOPE
Eased Haylie ’ s Stomach Pain
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Until recently , performing an upper GI endoscopy with biopsies for a child who has eosinophilic esophagitis ( EoE ) required deep sedation or general anesthesia and a four-hour stay at the hospital . To best monitor and treat this condition , that child may need this procedure every six to eight weeks .
This was the case for 12-year-old Haylie Nielsen , whose chronic stomach pain had her doctors at Children ’ s Hospital Colorado – Joel Friedlander , DO , and David Fleischer , MD – suspecting she had EoE and food allergies .
Besides the inconvenience that a traditional endoscopy brought for Haylie and her family – following intense NPO guidelines , staying in a hotel the night before , a full day ’ s recovery – there was another problem : Haylie was allergic to certain types of anesthesia .
Doctors at another hospital first discovered this allergy when Haylie woke up from an unrelated surgery with a severe allergic reaction – an event that caused her great pain , and her mother , Michelle , great anxiety about future procedures .
To evaluate and treat Haylie ’ s condition after her first therapy , her caregivers needed to perform a follow-up endoscopy . Though anesthesia experts from Children ’ s Colorado ensured she wouldn ’ t have an allergic reaction , it didn ’ t keep her mother from worrying . Michelle couldn ’ t imagine enduring that anxiety through more endoscopies until Haylie was better .
At about that time , Dr . Friedlander consulted with his colleagues Jeremy D . Prager , MD , pediatric otolaryngologist , and Emily DeBoer , MD , pediatric pulmonologist , in Children ’ s Colorado ’ s Aerodigestive Program , who were pioneering a new way to monitor treatment in EoE : pediatric transnasal esophagoscopy / endoscopy with biopsies ( TNE ).
While used at times in adults to monitor Barrett ' s esophagus , no one had yet studied it for EoE or in young children . Furthermore , the endoscope used for unsedated transnasal endoscopy in adults was 4.9 millimeters in diameter – too big for most children .
But Dr . Friedlander knew that the Aerodigestive Program had been using similar endoscopes between 2.8 and 4 millimeters in diameter to perform pediatric bronchoscopy or flexible laryngoscopy . Could that tube work for pediatric TNE with biopsies ?
Dr . Friedlander and his colleagues invited 22 children to participate in a study to see if it would work , including Haylie . Though the procedure was momentarily uncomfortable for Haylie , it was faster , safer , and more convenient , and it put her mother at ease .
The new procedure , which takes place in an outpatient exam room , uses a numbing agent on the nose and throat and then threads the endoscope through the nasal passage into the esophagus and stomach . Dr . Friedlander then takes tiny pieces of tissue through the endoscopy for evaluation . The procedure takes seven to eight minutes , and the patient is at the hospital for a total of 45 minutes , maybe an hour .
Haylie has since had three TNE endoscopies . “ It has worked out amazingly ,” Michelle says . “ It obviously saves us from the worry of going under . It ’ s so fast .”
Through these new transnasal endoscopies , Dr . Friedlander and Dr . Fleischer discovered that besides having EoE , Haylie was also allergic to wheat . Now armed with the appropriate medication and diet , Haylie ’ s stomach pain has subsided and her EoE appears to be under control .
For the other 20 children who ended up participating in the study , Dr . Friedlander and his colleagues found the procedure to be an overwhelming success .
“ We ' ve been searching for many years for ways to monitor this disease without anesthesia ,” Dr . Friedlander says . “ This technique really opens up the possibility to monitor and treat this disease much more aggressively without repetitively putting children asleep . It does this at approximately onethird of the cost and allows children and parents to return to their normal activities immediately after leaving the hospital .”